Healthcare Provider Details

I. General information

NPI: 1720445059
Provider Name (Legal Business Name): BETH A YEAGER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2016
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5930 MAHOOD DR
HUNTINGTON WV
25705-2210
US

IV. Provider business mailing address

5930 MAHOOD DR
HUNTINGTON WV
25705-2210
US

V. Phone/Fax

Practice location:
  • Phone: 304-955-5111
  • Fax: 740-295-5372
Mailing address:
  • Phone: 304-955-5111
  • Fax: 740-295-5372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2014-3199
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: